A preference to lie in the knee-chest position was associated with increased intracranial pressure (ICP) in three children, ages 12 and 20 months and 4 years, reported from the Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel. The forehead touched the floor on a level with the chest and knees, and the rest of the trunk was elevated so that the buttocks were uppermost. The 4-year old child had a mass in the pineal area, with obstructive hydrocephalus; the 20 month-old had pseudotumor cerebri that responded to acetazolamide and a return to a normal posture; the 12-month old had a cerebellar astrocytoma and obstructive hydrocephalus. The authors postulate that the knee-chest position favors a reduced pressure in the right heart atrium, thus augmenting the blood flow from the superior vena cava and dural sinuses. [1]

COMMENT. In infants and young children with brain tumors and few signs or subjective complaints, the knee-chest posture might be helpful in the clinical suspicion and diagnosis of increased intracranial pressure. This posture is also assumed by children with cyanotic heart disease and is a characteristic sign of acrodynia.